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American Journal of Critical Care. 2006;15: 600-609
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CE Article

Effect of Continuous Display of Cerebral Perfusion Pressure on Outcomes in Patients With Traumatic Brain Injury

By Catherine J. Kirkness, RN, PhD, Robert L. Burr, MSEE, PhD, Kevin C. Cain, PhD, David W. Newell, MD and Pamela H. Mitchell, RN, PhD. From Biobehavioral Nursing and Health Systems (CJK, RLB, PHM), Biostatistics and Office for Nursing Research (KCC), University of Washington, Seattle, Wash, and Seattle Neuroscience Institute at Swedish Medical Center, Seattle, Wash (DWN).

Corresponding author: Catherine J. Kirkness, RN, PhD, Room T617, Biobehavioral Nursing and Health Systems, 1959 Pacific NE St, Box 357266, University of Washington, Seattle, WA 98195-7266 (e-mail: kirkness{at}u.washington.edu).

• Background Clinical bedside monitoring systems do not provide prominent displays of data on cerebral perfusion pressure (CPP). Immediate visual feedback would allow more rapid intervention to prevent or minimize suboptimal pressures.

• Objective To evaluate the effect of a highly visible CPP display on immediate and long-term functional outcome in patients with traumatic brain injury.

• Methods A total of 157 patients with traumatic brain injury at a level 1 trauma center who had invasive arterial blood pressure and intracranial pressure monitoring were randomized to beds with or without an additional, prominent continuous CPP display. Primary end points were scores on the Extended Glasgow Outcome Scale (GOSE) and Functional Status Examination (FSE) 6 months after injury. Secondary end points were GOSE scores at discharge and 3 months after injury and FSE score 3 months after injury.

• Results Although GOSE and FSE scores at 6 months were better in the group with the highly visible CPP display, the differences were not significant. Slope of recovery for GOSE and FSE over all follow-up time points did not differ significantly between groups. However, the intervention’s positive effect on odds of survival at hospital discharge was strong and significant. Within a subgroup of more severely injured patients, the intervention group was much less likely than the control group to have CPP deviations.

• Conclusions The presence of a highly visible display of CPP was associated with significantly better odds of survival and overall condition at discharge.

Notice to CE enrollees:
A closed-book, multiple-choice examination following this article tests your understanding of the following objectives:
  1. Identify the relevance of knowledge of CPP level to nursing care.
  2. Identify the most critical CPP threshold level supported by findings of this study.
  3. Discuss findings of the research related to continuous display of CPP on the outcomes of patients with traumatic brain injury.

To read this article and take the CE test online, visit www.ajcconline.org and click "CE Articles in This Issue."






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